An 18-year-old woman seeks an opinion about swelling in her right leg. She first noticed it 1 year ago when her pants seemed to be tighter on that leg. She has no pain or discomfort; the edema does not improve after nocturnal rest.
On physical examination, the left leg is normal, and on the right the edema involves the toes, which look squared, along with nonpitting edema in the foot. The skin appears thickened, and there is a 4-cm difference in diameter between the legs measured in the calf. She has no adenopathy, and the abdominal examination is unremarkable. A diagnosis of lymphedema tarda is rendered.